Learning to be a coper without an ACL

[MaineSkiLady]

Found this overview of meniscus issues that includes diagrams of common tear types. Can see clearly why someone with a "bucket tear" should have surgery.
https://www.stoneclinic.com/meniscus-tear

Bucket handle tear. DH had this. Could get nowhere near full extension in "pre" hab. MRI inconclusive but surgery bore out the tear type, surgeon even took a scope screen shot pic of him "unflapping" it. He did opt to go the full surgical route for ACL, but we know several very active skiers who are fully functional without. Sounds like you're definitely one of them!

 

[marzNC]

MSL: Thanks! Although I was pretty confident, my return to skiing went better than I expected. I don't think I'll be holding back when I get to Big Sky and Alta for my late season trip.

I think there are many advanced/expert skiers without an ACL. Few mention it publicly though. I came across single posts or a mention by a friend in online forums for not only alpine skiing, but other sports like rock climbing, golf, tennis, and even soccer. Turns out there are a couple professional basketball players who lost an ACL in high school. Of course, they were young enough to build up plenty of compensating muscle around the knee pretty quickly.

 

[marzNC]

My journey just started on Sunday, 2/3/13

I guess I'm in the felt a "pop", no pain, minimal swelling group.
I was skiing a few small moguls--on the 4th I absorbed and felt the pop. I didn't fall until afterwards. Then, I didn't feel like I had the strength or stability to get back up. When I realized that there was no way down to the base mountain from where I was, I called for ski patrol.

I still have no pain--just a lot of stiffness from wearing a brace the first couple of days. I can straighten my leg all the way, but not bend all the way yet. I just keep doing ROM exercises and lots of ice (Aircast Cryo Cuff). I didn't use crutches at all yesterday since I was in the house and didn't walk any long distances. Today, I hope to keep to 1 crutch and make sure I'm walking heel-to-toe without a limp. I cannot find any point tenderness with the LCL or MCL. It is rare that just the ACL is injured, but I'm hopeful at this point. MRI will be today (Friday) or Tuesday. Doc on next Friday.

I'm hoping to be a coper. That way, I figure if I do need surgery down the road, I'll have had plenty of pre-op physical therapy to become as strong as possible. Also, I want to lose as much weight as possible, before surgery.

Sorry you have joined the ACL injury club. Happy to provide what ever info I can. But every situation is different. Your PT and surgeon are the ones to listen to the most.

The only time I felt pain related to the MCL strain was trying to do an abductor (or was it adductor) exercise at my first PT session. That was at about 3 weeks after injury. The first couple weeks of PT involved exercises lying down or sitting . . . no strain on the knee. The idea was to start building up hamstrings and the hip add/adb muscles. Plus work slowly on ROM. A week or two later, the MCL strain was no longer a problem.

For sleeping, I would use an extra pillow under the knee. As well as one next to the leg to keep the blanket up and away. Seems like I did that for about six weeks.

I did not use ice after the first week. Even after PT, I didn't have swelling so I did not ice afterwards. As mentioned earlier, I followed the Chinese medicine approach and used heat instead. Also acupuncture.

 

[RX2SKI]

I used 1 crutch around work today--I think it was more for safety to keep anyone from walking into me. At home and my MRI appt today, I didn't use anything. The only issue I'm really having at the moment is bending my leg to get in and out of the car--I've got to remember to keep the seat all the way back when I leave. Tried stepping up onto the sidewalk with the bad leg, and seemed alright. There's a part of me that is holding out that it's not the ACL, but that dang pop I felt makes it highly improbable. Still amazes me that the ER wasn't doing any manual tests. Finally got her to do an Anterier Drawer and she felt an endpoint. Ortho only wiggled my patella around and did a Lachman's test, but only on 1 knee. I did take a few athletic training classes in college and they were a long time ago, but I wouldn't call either person's exam "thorough". We always started with the uninjured limb to find the patients norm and then repeated the tests on the affected side. To give him the benefit of the doubt, maybe he didn't want to cause unnecessary pain. But I have one heck of a pain tolerance and would rather know what is potentially going on. The MRI is only one piece of the puzzle and has to be looked at in conjunction with the symptoms. I guess they just figure the gold standard is the MRI and just wait for the results to come in.

 

[marzNC]

RX2SKI: my family physician did way too much manual manipulation. Made the knee hurt more than once because of the MCL strain. Then she said I was "guarding" so much that she couldn't tell anything! Sent me for an X-ray, which didn't show anything as I expected. The ortho PA checked both knees. He was much more careful. Demonstrated the tiny bit of laxity in the injured knee. My PT was conservative and assumed the ACL was shot until the appt with the surgeon a couple weeks later. He gave me plenty to work on so there was no reason to push.

One thing I did extra for improving proprioception was to stand with weight on one leg with my eyes closed . . . while holding onto something solid. After a week or two, I was picking up the other leg. Did it for both legs. I found that watching my bad knee while doing something, even just walking, was helpful while re-training.

I did heel slides several times a day. Usually 5-10 at a time, starting as soon as I woke up.

I found these self-massage videos useful, especially for the calf and knee.
https://selfmassageforathletes.com/Videos.html

 

[RX2SKI]

I know that it is possible to have a completely torn ACL and still ski on it. I know someone who skis on his with just some sort of brace for support. I was not in that situation. I had surgery immediately (6 weeks) after the swelling went down. Definately a non-coper here. I couldn't get around without an immobilizer at first and then later a hinged thigh-to-ankle number.

Best of luck to you. Sounds as if you have the support, desire and body mechanics to succeed.

I'm curious who did your surgery. My ortho is Dr Cooney at Front Range Orthopedics.

 

[marzNC]

Since some people who find this thread are probably curious about what can be involved after ACL reconstruction surgery, thought I'd note this blog. The blogger is a man who was in his late 40's when he had ACLr surgery in 2007. He opted for surgery mainly because he plays competitive and social tennis. He is a Ranger (helps ski patrol) at Wachusett and popped the ACL while skiing. There are a few useful short videos, plus relevant comments.

https://myaclreconstruction.blogspot.com

 

[marzNC]

For more about my life as a successful coper, click here.

 

[marzNC]

Decided to check kneeguru.com to see if there was anything of interest recently. Lead to a new blog by someone who really messed up a knee (not skiing) in April 2013. The blogger decided on ACLr surgery because karate is important. However, the detailed write up about pre-hab is pretty much the same as what a coper would do.

https://ihurtmyknee.org

My on-ongoing thread is
https://www.theskidiva.com/forums/i...ry-no-problem-my-new-normal-as-a-coper.15049/

 

[marzNC]

The best approach soon after ACL injury is to start formal PT. If you cannot do that for whatever reason, here are a few of the most basic exercises that my PT had me doing even before we were positive the ACL was completely gone. Heel slides, firing the quad muscle, and using a towel under the bad knee to increase extension. Can be done multiple times a day until full Range of Motion is achieved.

 

[marzNC]

Learned more about quad strength from a website of the Knee Clinic in Australia. Already knew that best to avoid strengthening quads too much in relation to hamstring strength. My PT was much more about hamstrings than quads. This webpage also include good graphics showing where grafts are put as well as a very simple timeline for post-surgery rehab.

https://www.kneeclinic.com.au/papers/ACL_for_Patients/ACL_Patient _Info.html
Non-Surgical Treatment
Physio is extremely important after an ACL injury regardless of whether or not you decide to have it repaired. It is important to strengthen both the quadriceps (muscles on the front of the thigh which straighten the knee) as well as the hamstrings (muscles on the back of the thigh that bend the knee). Because they tend to pull the tibia backwards, the hamstrings can help prevent the tibia from sliding forward in a knee without an ACL. Quadriceps strengthening should be done under supervision of a physio as the quadricepts can pull the tibia forward in knees without functional ACL's. Balancing and proprioception (the body's ability to sense the position of joints and muscles) should also be developed with agility training. It normally takes 6 months before one would complete physio to the point of being able to participate in sport. Even then agility sports such as soccer, netball, rugby or volleyball would present a high risk for re-injuring the knee.

 

[marzNC]

I looked at a lot of exercise videos last year during rehab. Below are three that I think can be started during the early stages. For dynamic balance and some of the Bosu work, the videos provided a goal to work towards. They are also very good for maintenance or getting ready for ski season.

My on-ongoing thread is
https://www.theskidiva.com/forums/in...ry-no-problem-my-new-normal-as-a-coper.15049/

 

[marzNC]

Given the continuing interest in this thread, it's reach 6000 views in a year! Hope it's been helpful to those who are copers or are still considering their options after an ACL injury.

Here is another thread by a successful coper who skis. Younger and more active than I am.
https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=62219.15

Click here for my ongoing thread.

 

[marzNC]

For anyone reading my ACL-related threads who is thinking about surgery vs. no surgery, the blogger I mentioned in June is an example of a possible downside of surgery. Her complication happens about 5% of the time. She found out about the issue 3-4 months after surgery.

https://ihurtmyknee.org/2013/11/21/mri-the-verdict/

Another 1000 views this fall.

I've already started my second ski season after injury. The on-going thread is
https://www.theskidiva.com/forums/in...ry-no-problem-my-new-normal-as-a-coper.15049/

 

[marzNC]

Came across a recent article in the journal Osteoarthristis and Cartilage looking at copers after 20 years. Not that big a group, but the conclusion is quite clear that successful copers do not have any more knee cartilage issues when compared to people with normal knees. In short, there is no indication from this study that copers are more likely to have OA than people with normal knees.

* * *
CONCLUSIONS
Subjects who have managed to cope with their ACL injury for 20 years with sustained good subjective knee function also seem to have knee cartilage of good quality, with T1Gd values not very different from a healthy reference group.
* * *

 

[marzNC]

Over 8000 views. Wow!

My second ski season after injury is going great. Learning how to deal with bumps better with the help of more than one instructor, including one at Jackson Hole. The on-going thread is
https://www.theskidiva.com/forums/in...ry-no-problem-my-new-normal-as-a-coper.15049/

 

[Pequenita]

The following article is merely food for thought. I skied for over a decade with a partially torn ACL (verified with arthroscopic surgery).

https://www.outsideonline.com/fitne...njury-Do-I-Have-to-Get-Surgery-On-My-ACL.html

 

[marzNC]

The following article is merely food for thought. I skied for over a decade with a partially torn ACL (verified with arthroscopic surgery).

https://www.outsideonline.com/fitne...njury-Do-I-Have-to-Get-Surgery-On-My-ACL.html

Interesting that the study by Dr. Marx is starting to make the rounds again. I guess because it's ski season in the U.S. The original study report came out a year ago, in early 2013. The key point he wanted to make in various interviews was that waiting 6-8 weeks before making any decision about surgery was probably a good idea for ACL injuries that occurred while skiing. Of course, important to be doing formal PT and to avoid any further injury during that period. Dr. Marx had enough past patients to have a decent study group for a retrospective study with 2-year follow up.

https://www.drrmarx.com/articles/kn...-acl-injury-in-recreational-alpine-skiers.php

 

[marzNC]

Up to 9400 views. Unfortunately that probably means some folks are in the midst of trying to decide what to do about an ACL injury. If you are in that situation or know someone who is, remember that getting advice from an orthopedic specialist is important. The knee is complex and every situation is unique.

My ski season ended with a record of 60 days on snow. Had a couple more lessons during the last ski trip, which was to Alta in April. I have little doubt that high level lessons from Level 3 or equivalent instructors is a great investment for both more skiing enjoyment and injury prevention.

My on-going thread is
https://www.theskidiva.com/forums/in...ry-no-problem-my-new-normal-as-a-coper.15049/

 

[marzNC]

The following thoughts are based on a post I wrote in 2013 in another thread about a knee injury that included a full rupture of the ACL. It's a good one to read for those who are leaning towards ACL reconstruction surgery.

https://www.theskidiva.com/forums/index.php?threads/complete-acl-rupture.15988

There is a lot more to a knee than the ACL. Someone who tears/ruptures an ACL and does major damage to other ligaments and/or the meniscus is in a completely different situation than someone who blows an ACL but has no pain, no other significant damage to other parts of the knee, and no instability incidences. Assuming both patients get a full diagnosis soon after injury, are consulting knee specialists, and are being careful to avoid further damage. Ongoing pain is bad . . . period. How someone with a bad knee opts to treat the problem is a very personal decision that should take into account life style as much as medical advice from a specialist who has manipulated the injured knee and the MRI.

The ACL is the only ligament completely internal to the knee. As a result, it gets little blood flow. That's why a torn MCL can heal, given enough time, but an ACL is much less likely to heal. That's why surgery to re-attach a torn ACL did not turn out to be a useful surgical technique. ACL reconstruction surgery is invasive, requires drilling holes in bones, and requires a lengthly healing phase (months, not weeks) before the final stages of PT and unrestricted activity can resume. Certainly well worth it for certain cases. In others, perhaps as much as 10%, revision surgery is required or there are long term issues. The decision about ACLr surgery should not be rushed when there is no pain and no instability IMHO. Try to think longer term, not just the next six months or next ski season, but more the next 10 years, or even the next 20-30 years.

I was in my 50's when I blew an ACL in June (not skiing). My parents were going strong physically at age 90. That was a factor in my decision to work at being a coper for at least a year first. I was willing to adjust my skiing for a season if needed. It took at least six months for the meniscus tear (red-red zone) to heal without intervention. Had I still wanted to play tennis or volleyball, my decision would probably have been different. I was skiing about seven months after injury, three months after finishing with formal PT.Getting an MRI shortly after the initial swelling goes down is well worth it if there are strong indications that the ACL was torn. Starting formal PT within days or at most a few weeks of messing up a knee is highly recommended.

Ultimately, your ortho surgeon is the best source of advice for your situation.

The bottom line is that popping off an ACL definitely does not mean the end of skiing. My on-going thread about skiing better than ever as a coper is here.